How can Osteoporosis be treated?
Until recently, treatment of osteoporosis was limited to hormone replacement (estrogen in women and testosterone in men) plus physical exercise and a high calcium intake. In the past several years we have seen an explosion of new chemicals and modalities used to treat this extremely common disease. Thanks to the efforts of the National Osteoporosis Foundation (NOF) and the development of accurate bone density measurements, there has been immense interest and progress in the recognition of and treatment of the disease.
Hormone Replacement Therapy (HRT) is still the mainstay of osteoporosis treatment, but there are several new estrogen compounds and progesterone compounds that greatly expand the acceptance of hormone therapy. There is one new estrogen compound, Evista, (and several more like it are in the works) which acts like estrogen on bone but has no estrogen effect on the uterus. It seems to have a protective effect against breast cancer as well and this may have some heart protective effect as well. This should allay the fears of many women about hormones and breast cancer. For men, testerone is available as an injection, a patch, and soon as an under the tongue dissolvable tablet. Oral testosterone tablets are too toxic to the liver to be used for the treatment of male osteoporosis. Estrogen has been recommended as treatment for osteoporosis in almost all women because it not only protects against and treats osteoporosis, it also protects against hardening of the heart arteries (coronary arteriosclerosis) and other blood vessel conditions which can lead to heart attacks and strokes. (For women who cannot or do not want to take estrogen, there are other methods of protecting against heart attack and stroke which are as effective if not more so then estrogen.) Estrogen is available as tablets, skin patches, creams, vaginal tablets, and "natural sweet potato based" phyto-estrogens that for some women, is as potent as "premarin" and "prempro" and easier for them to take. The same is true for progesterone.
Calcitonin, a bone related hormone, is also very effective. Miacalcin is available as a nasal spray or as a subcutaneous self-injection, and has the advantage of reducing the pain of osteoporosis faster than most other treatments. Osteoporosis can be painful with or without fractures. This pain relief is as effective as narcotics and is much longer lasting - when the pain goes away, it usually stays away.
Calcium supplementation has been a mainstay of the treatment of osteoporosis
for many years. Unfortunately very few physicians, clinics, or centers
monitor the use and effectiveness of calcium supplements adequately. Calcium
supplementation must be monitored and measured to determine if the amount
taken a sufficient or in excess, which can lead to such problems as kidney
stones. Additionally Vitamin D status must be measured and monitored to
make the most of calcium supplements.
Exercise has been shown to prevent and sometimes even reverse osteoporosis. Weight lifting and/or power walking (3 miles in 45 minutes or less, four times per week) have been shown to be very effective in this regard. Weight lifting three times per week has also been shown to be very effective in women and men as old as 85.
A class of chemicals called biphosphonates is very effective in preventing and reversing osteoporosis. Didronel was the first of these chemicals. Fosamax is a very well known and well publicized biphosphonate, but it causes stomach and esophagus problems in many people, and the need to take it first thing in the morning on an empty stomach with 2 large glases of water is a turnoff for some and difficult to comply with. There are several other biphosphonates which are easier to take than Fosamax, and more effective. Some are tablets that can be taken twice a week and some can be given intravenously once every 3 months.
How is the effectiveness
and response to treatment monitored?